As I’ve written before (here and here) I think there is tremendous potential for Health and Wellbeing Boards (HWBs) to make a huge difference through their Joint Health and Wellbeing Strategies (JHWSs).  But it’s deceptively complex.

Who can’t write a health and wellbeing strategy?  Yes, but can you not only write one, but collectively generate a coherent and workable approach which will simultaneously fill the financial hole (£22bn a year by 2020 in health alone across England), tackle the entirely preventable factors leading to early death (obesity, inactivity, social isolation etc.) and tackle the inequalities that mean that some people die 20 years earlier than others and that some live considerably more miserable lives?

Working on this in our local Healthwatch and HWB, one difficulty I found is keeping the whole, big picture in mind at once.  It’s not that we’re not aware of the different elements, but there’s a tendency to just focus on one or two parts.  In our case it’s tended to be a focus on particular conditions (mental health, dementia etc.) or groups (frail elderly, looked after children) rather than getting to grips with the whole prevention agenda and the wider determinants of health.  Other strategies I’ve seen focus exclusively on prevention to the exclusion of services.

  So I drew a diagram (attached) that sets out the key elements a strategy could focus on – those things that could make most long term difference to efficiency, quality and equality.  Those elements (which can also be found in the Five Year Forward View and a number of other documents) are:

• services (making health and care services better, integrating, restructuring, Better Care Fund, new models of care etc.)
• prevention (individual risk factors and the wider determinants of health)
• innovation and technology (new ways of doing things, exploiting ICT and other technology)
• co-production (self-care, peer support, the role of carers, the public as equal partners in the wider health and wellbeing system)

It’s not the only way of looking at things, but I find it a useful one.  It’s imperfect and also only a first step (not that many places are still at that first step, but we all need to keep going round the Escherian staircase).

Some of the other things that need to be done are:

• Wider conceptual mapping – building on this framework, to have several other diagrams from different perspectives providing an overall sense of the territory you’re working in
• Desk research to identify areas where it is possible to make the biggest improvement over various timescales.  For instance, what is the maximum possible impact on premature mortality, quality of life and health inequalities of reducing obesity, increasing physical activity, service integration etc.?  We see figures on those things every day, but usually in relation to individual causes or conditions; it is rarely brought together in a way that would enable us to make comparisons and choices.
• Engagement with stakeholders and the public – all the professionals, agencies and members of the public who can make change happen.  Or stop it happening.
• Analysis, to see what’s possible, how the system works as a whole, what the points of leverage are and where there is potential to generate non-linear effects through positive feedback loops
• Build the components together into a coherent, long term strategy, recognising that there is too much complexity for a blueprint, and there is a need for regular revision and adaptation
• Implementation and delivery.  The strategy should be clear and compelling enough to drive commissioning, not just of health and social care, but other services too.  It also (as the framework suggests) needs to drive change beyond simple service delivery, including changes in how the public addresses its health and wellbeing.
• Reviewing, learning and revision of the approach and objectives.  This includes learning from experience, learning from each other locally and learning from other areas.

Again, it’s not as if these things aren’t being done.  But are they being done well enough anywhere to make a substantial difference?

Isn’t this something where there’s great scope to learn from each other and develop approaches together?  If you’re registered with the LGA’s Knowledge Hub, I’ve started a forum thread on the HWB group, so why not contribute any experiences or ideas there?  Otherwise why not give any thoughts below?